Couples Therapy for Extramarital Affairs

In Couples Therapy for Extramarital Affairs, Dr. Don-David Lusterman demonstrates his empathic, psychoeducational approach to working with couples in which one partner has had an affair. Therapy begins with acknowledgment of the "victim" status of the partner who discovered the affair. Dr. Lusterman then works to restore trust and helps the discoverer to transcend the role of victim by encouraging empathy in the offending partner for the discoverer's feelings. In this session, Dr. Lusterman works with a couple in which the husband has admitted to an affair with a coworker. The emotionally charged nature of this session requires the therapist to actively guide the couple away from the dynamic of blame and blame-avoidance toward honesty and openness.

This video features a client portrayed by an actor on the basis of actual case material.

Precipitating Events

David and Sharon have been married for 16 years and have three children, two boys and a girl, ages 10, 8, and 1. One month before the couple sought therapy, Sharon had discovered and David had confirmed that he had been having an affair for about 6 months with a younger associate at his law firm, a woman named Camilla.

Sharon had been alternately enraged and accusatory, despairing, and self-blaming. The couple spent several sleepless nights in which Sharon grilled David about the details of the affair. He would answer some of her questions and then plead for her to put the whole thing behind them, maintaining that it only made things worse to talk about it.

In the week following the admission of the affair, the couple had talked about how they might work things out. David ended the affair and agreed to stop working with Camilla at the firm. Sharon arranged for a regular babysitter on Saturday nights so that she and David could spend some time alone nurturing and repairing their relationship, which both agreed they had neglected over the years.

Sharon remained suspicious, however, and called David frequently during the day to check on his whereabouts. He responded defensively, telling her she would have to begin trusting him again if the marriage was ever going to work out. Sharon felt surges of rage whenever she thought about the affair, but she felt afraid to express her emotions for fear of driving David further away. She obsessed about the details of what she already knew about the affair, was irritable with the children and with David over minor matters, and had difficulty sleeping.

About a week after the discovery, Camilla attempted to call David at home but he was not there, and she spoke to Sharon instead. Camilla intimated to Sharon that the relationship was continuing, at least on a collegial basis. This precipitated a second crisis for Sharon, who confronted David and threatened to leave. David explained that while he had ended the affair, he had less control over whether he and Camilla would continue working on cases together.

The issue remained unresolved between them, and the next day Sharon decided to call Camilla at work and convince her to leave the firm, for the good of them all. Camilla told Sharon that that was out of the question; because David had started the affair over a year ago, he should be the one to leave the firm, if anyone needed to go. Sharon was devastated as she realized that David had been having the affair while she was still pregnant with their third child.

Traumatized by this revelation, Sharon panicked and made arrangements to move out the next day with the children. She would temporarily live at her parents' home until she decided what to do next. David overheard her making plans with a moving company over the telephone and pleaded with her to go with him to marital therapy at least once; if she still wanted to separate, he said, he would move out. Reluctantly, Sharon agreed. David got a referral from a friend and made an emergency appointment with Dr. Lusterman for the next day.

Questions

• What is your impression of Sharon and David?
• How typical or atypical are their life experiences and current behavior?
• What do you believe are the core issues for Sharon and David?
• What is the utility of these initial formulations?
• Before you read the next section, what topics and issues do you think will be addressed in the initial sessions?

Initial Sessions

Session 1: The major focus in this session was on Sharon's intense suspicion that David and Camilla were still romantically involved. Dr. Lusterman worked with David to help him accept Sharon's anger and suspiciousness, urging him to keep the focus on her pain and explaining that she was experiencing an absolutely normal and predictable posttraumatic reaction.

Dr. Lusterman gave the couple two articles he wrote about the discovery of infidelity, suggesting that they read the articles together and talk about them with one another. He emphasized again the normality of Sharon feeling as if her life were falling apart and commented that the articles would help David understand the kind of actions he could take to help ameliorate these feelings of disintegration.

David responded that he wished that Sharon would stop going over every little detail of the affair and its discovery and that she would "leave Camilla out of it." Dr. Lusterman pointed out that each time David says this, it reminds Sharon of how David tried to silence her when he was involved in the affair. It also reminds Sharon of his initial denial of the affair. Dr. Lusterman explained that this triggers further posttraumatic reactions and suggested to David that the more he expresses understanding of Sharon's fears, the more easily she will be able to calm herself.

Dr. Lusterman ended the session by pointing out that the object of their work together would be change, change being either a better marriage or a better divorce.

Session 2: Dr. Lusterman began the session by commenting that his plan had been to gather some background information on Sharon and David as individuals and as a couple, as a prelude to doing some very systematic work over the next few sessions. He noted, however, that any crises that had occurred between sessions would always take priority in their sessions.

Given that Sharon had called him midweek, upset, he asked if she wanted to spend some time talking about what had been bothering her. He reminded the couple about his confidentiality policy—he would reveal that contact was made by either of them but would not disclose the content.

Sharon said that she had already spoken with David about old letters she had found from Camilla in David's desk. She described how she had felt overwhelmed after reading the letters and was convinced that David was still involved in the affair. She had felt compelled to question David over and over to make sure that there was nothing going on between him and Camilla.

David replied that they had both read the assigned articles earlier in the week and that he had tried to apply what he had learned to Sharon's concerns about the letters. He said that he had listened patiently to Sharon's worries as the reading suggested, but that it hadn't worked, and he was discouraged. Sharon responded that David might have thought he had been listening, but she perceived that he had been trying to make her stop talking about it, which increased her feelings of suspicion and made her feel that he really didn't care.

Dr. Lusterman coached David to try again in the session, with better results this time. Following this success, Dr. Lusterman pointed out that given the trauma the couple had experienced, it was normal that they would have experiences of "one step forward and two steps back." For example, things could be going pretty well, but a small reminder of the affair could easily trigger a new episode of distrust and anger, a "flashback" of sorts.

At this point, Sharon admitted, and David agreed, that it had in fact been a good week in which they had made love several times and talked more intimately than they had in a long time. But the discovery of the letters had seemed to erase the hope that had engendered and raised all the old doubts again. As Sharon cried, David embraced her and told her how terrible he felt that he had lied to her.

Dr. Lusterman closed the session by focusing on remorse, pointing out that acts of admission and remorse set the stage for healing from the affair and for improved communication in general. Noting that the history taking planned for the session would need to occur at another time, Dr. Lusterman congratulated the couple on weathering the crisis precipitated by the letters.

Session 3: Sharon began the session by describing her continuing bouts of distrust and her uncertainty as to whether she could stay in the marriage. David acknowledged in the session, in a much more patient way than he had previously done, how painful her feelings of betrayal must be.

Within this positive and calmer context, Dr. Lusterman asked the couple to share some history about their marriage and their families of origin. The couple chose to discuss their respective families, beginning with David's.

The two themes that emerged were David's tremendous need to please and how this had led him to hide many feelings and thoughts from his family. One major example had been his refusal for many months to disclose his reluctance to attend medical school and his planned subterfuge to hide his real situation from his family. All of this was discussed in the context of David's competition with his older charismatic brother and his family's perceived expectations of David's career success.

Dr. Lusterman linked David's subterfuge with regard to his career choice in his family with the subterfuge in the affair, pointing out that deficits in self-disclosure were often factors in marital infidelity. He noted that there appeared to be many times prior to the affair that David could not share with Sharon his deepest feelings if he felt they might injure his position as a "good guy." Dr. Lusterman noted further that because Sharon and David had never learned to communicate well, it was hard for them to problem-solve, and many conflicts in the marriage over the years had been swept under the rug.

With a few minutes left in the session, Dr. Lusterman asked Sharon about themes of secrecy in her family. She disclosed that as an adolescent she had discovered that her father was having an affair. She had felt devastated but had felt protective of both of her parents and so had never disclosed the affair to her mother or let her father know that she knew.

Dr. Lusterman ended the session by suggesting that next week they might discuss the impact of this discovery on Sharon's feelings about her own marriage and marital crisis.

Session 4: To be viewed.

Questions

• Were the initial sessions as you expected?
• As you read the summary of the preceding sessions, were there any areas or topics that you thought should have been covered but were not?
• What other information would you seek to assess the couple?
• What overall goals for therapy do you suggest?
• Before viewing the tape, what do you think will unfold in the taped session?
• What issues will be discussed?
• What will the relationship between Dr. Lusterman and the couple be like?

Stimulus Questions About the Videotaped Session

Early in the session, the issue of Sharon's current level of trust in David is discussed, and Dr. Lusterman asks Sharon to rate how trusting she feels on a 10-point "pits to Ritz" scale.

• What are the merits of using numerical ratings to assess clients' feeling states?

About 8 minutes into the session, as Sharon and David are struggling with their communication difficulties in the session, Dr. Lusterman transitions from their struggles as a couple to similar struggles in their families of origin.

• How do you know when and whether to make such a link in a session?

About 12 minutes into the session, in the context of discussing David's business travel and Sharon's concerns about the possibility of his traveling with Camilla, Dr. Lusterman addresses Sharon and David's lack of quality time alone together. He softly suggests that their taking a vacation together without the children would "not be a bad idea."

• At this important choice point, would you personally have explored further Sharon's feelings about David's continuing relationship with Camilla?
• Would you have discussed the paucity of the couple's quality time alone?
• Or, would you have pursued some other issue with the couple?
• In any case, how did you respond to Dr. Lusterman's soft style of suggesting that taking a vacation might "not be a bad idea"?

About 14 minutes into the session, for the second time, Dr. Lusterman invokes consideration of Camilla's probable feelings in response to being part of a triangular relationship.

• What might be the therapeutic rationale for raising this matter?
• What impact might raising it have on the couple in the session?

About 18 minutes into the session, David begins to sincerely and directly express his love for Sharon, his remorse over the affair, and his commitment to the relationship, which precipitates a tearful reaction from Sharon. David pauses, and Dr. Lusterman elects to remain silent.

• On what basis would you, as the therapist, decide to intervene or remain silent during a pause in the midst of genuine emotional communication between a couple?
• What effect does Dr. Lusterman's silence appear to have in the session?
• What might alternative therapist responses lead to?

About 20 minutes into the session, Dr. Lusterman reminds the couple that he has only a few ground rules for marital therapy. One is that the decision to remain married is theirs. He will follow their decision-making lead. He remarks that he is "in the change business," which in the case of couples therapy means helping them to have either "a better marriage or a better divorce."

• As a marital therapist, would you be able to state your neutrality to couples and, more important, could you adhere to this neutrality with regard to the fate of a particular marriage?
• How would you articulate your position to a couple regarding the outcome of marital therapy and their decision regarding ending or continuing the marriage?

About 28 minutes into the session, Dr. Lusterman asks David, "What can Sharon do to let you know that she sees that you're in there trying?"

• What purpose do you think this request to communicate about communication serves?

About 30 minutes into the session, David again refers to his problematic history of trying to please everyone in his life. Dr. Lusterman observes that trying to please everyone can be hurtful. He then melds humor with a reference to Sharon's vocation as an artist by suggesting that she design an embroidery sampler for David that says, "PLEASING HURTS."

• What do you make of Dr. Lusterman's way of emphasizing this point?

Toward the end of the session, Dr. Lusterman reminds the couple that his typical procedure in marital therapy is to schedule at least some sessions with each person alone and that he wishes to see each of them alone over the next two sessions. He then asks the couple to flip a coin to determine who will be seen individually first.

• How would you determine the timing, frequency, and order of individual sessions in an ongoing course of marital therapy?

For much of the session, Dr. Lusterman works to enhance the couple's communication with and honesty toward one another and to increase their mutual trust. He often does so by encouraging the couple to directly communicate with each other and to confront the pain in their marriage, during which time he makes only occasional verbal interventions.

• Are you comfortable with this therapist style?
• For which types of couples and problems might this style be indicated or contraindicated?

General Questions

• Did the session progress as you anticipated?
• Were Sharon and David as you expected? Was Dr. Lusterman?
• What are you general reactions to the session?
• What did you feel was effective in the therapy?
• What do you think were the strengths and the weaknesses of this approach?
• Now, after reading about the couple and viewing this session, what are your diagnostic impressions or characterizations of their problems?
• How would you proceed with Sharon and David's therapy?
• How many sessions will it take?